Psoriasis Guide: Causes, Symptoms and Treatment

Table of Contents

"
Psoriasis (psoriasis vulgaris) is a chronic skin condition
characterized by dry, red plaques of thick skin that affects 1.5% to 2%
of the population. Dry flakes and scales are commonly found on
the scalp, face, back, elbows, palms, knees, and feet. In some people, Psoriasis may occur as a mild condition that is not noticeable,
while in other people, it may be a severe condition that affects the entire body It is classified into 5 categories with Plaque Psoriasis seen in up to 90% of cases.

The condition can be treated, but not cured. It is
thought to be triggered by environmental factors, stress, skin rubbing
and scratching, medications and alcohol use. Most children with
the condition start at age 8 while adults start to see signs at age 22.
In addition to skin lesions, most patients experience skin itch
(pruritis).

This is a
non-contagious but long-term skin condition where there is no cure. It follows a variable course, which can periodically
improve or worsen. In some people, the condition spontaneously clears
for years and stays in remission."

Psoriasis Symptoms on Leg Source: Meisenheimer Clinic

What is Psoriasis?

Psoriasis is an inflammatory immune-mediated disease that is primarily seen in joints and the skin. It is characterized by red skin patches, plaques and papules that are often itchy.

Examples of Plaque Psoriasis

Psoriasis vulgaris is a common disease worldwide, affecting 2% of the population. It is seen in both sexes and all races. Although it occurs in people of any age, the usual onset for most patients is early on in their adult years between age 20 and 30 and 50 and 60 (higher incidences during both 10 year age spans.)

In 30% of cases it is also seen in a first-degree relative such as a parent.

Psoriasis skin outbreaks will increase and decrease across the patients life.

What Causes Psoriasis?

The cause is unknown but
factors associated with Psoriasis include:

genetic predisposition

immune
system dysfunction

environmental influence

The condition runs in families and it may be triggered by environmental factors such as intake of certain medications and cold weather. Other factors include stress, dry skin, infections, and skin injury.

The specific cause of any symptoms are skin cells that rapidly
divide resulting in scaling and thickening skin.

Many people experience worsening of symptoms during the winter
months. Severe psoriasis can lead to social embarrassment, emotional
distress, job stress, and other personal issues.

Psoriasis Photos on Different Body Locations and for Different Types Source: Journal of Pediatric Dermatology

Eczema vs. Psoriasis

The difference between eczema and psoriasis is that psoriasis is an autoimmune disease whereas eczema is a hypersensitivity reaction to something that comes in contact with your skin.

Types and Symptoms

Psoriasis types are classified in five categories. Actual cases can overlap in more than one classification category.

Diagnosis

A doctor can diagnose the condition based on medical history
and physical examination. A skin biopsy may help confirm the diagnosis.
Other laboratory tests can help exclude other conditions or determine
the severity of the disease.

Psoriasis and Heart Disease

People with moderate-severe psoriasis have more cardiovascular risk factors. This is why patients with disease are encourage to follow a heart healthy diet and exercise plan that includes maintaining a normal weight. Studies show that people with higher body mass (BMI) are prone to more severe frequency and severity of psoriasis.(1)

Psoriasis Joint Pain

About 1/3 of people with psoriasis have what is called psoriatic arthritis. This autoimmune psoriasis arthritis disorder can degrade the body's joints, leading to joint pain.

Quality of Life

Psoriasis can affect the patients quality of life, even when not entirely visible. Emotional issues among psoriasis patients include:

Feeling stigmatized

Higher stress

Physical limitations

Alcoholism

Depression

Problems with employment

Treatment

Psoriasis treatment will depend on
the cause
and
accompanying symptoms which need immediate or long-term relief. Many psoriasis skin bumps are harmless and may go away on their own, while others may
need medical treatment involving topical medications, oral medications, phototherapy or
even surgery.

If you have just one area of the body with Plaque Psoriasis then it is fine to see your regular Doctor who will prescribe a topical ointment or cream. If multiple skin areas or other types of the disease are involved then see a Dermatologist.

Treatment may be directed at curing an infection,
relieving itchiness or inflammation, treating a systemic disease (like
a viral infection) or improving one’s appearance (cosmetic reasons).

One
may need to call a
doctor if skin
bumps are
accompanied by
symptoms that indicate severe inflammation or widespread infection,
such as fever, severe pain, and weakness. Immediate medical help is
needed in cases of anaphylactic or severe allergic reactions causing
difficulty in breathing and swallowing, swelling of the tongue,
hoarseness, dizziness, and loss of consciousness.

Mild scalp conditions calls for the use of Tar or ketoconazole shampoos followed by a topical lotion (betamethasone valerate 1%). For more chronic scalppsoriasis, the skin plaque is removed with a topical that contains 10% salicylic acid suspended in a mineral oil solution. After scales are shed, a cream or lotion that contains fluocinolone is left on the scalp overnight (covered by a plastic shower cap). Once under control, other lotions (clobetasol propionate) or calcipotriene lotion is used.

Palm (hands) and Sole (foot) Treatment

Topical glucocorticoids are used to treat the skin as well as phototherapy (PUVA).

Inverse Psoriasis

Topical glucocorticoids are applied for limited periods in some patients depending on skin condition. Others receive a vitamin D based topical such as atacrolimus. Tar baths or Castellani paint can be of help.

Nail Treatment

Topicals are used to treatpsoriasis in nails. The condition may go away on its own with no treatment. Phototherapy can be effective using high-intensity UVA light. Topical retinoids are effective as well. If the nail cannot be cured, then removal and regrowth is used.

Guttate Treatment

Any infection is treated with antibiotics. For localized conditions (in one area), phototherapy and UVB irradiation therapy can be effective.

Treating Severe Psoriasis"

Dr. Sonia Batra, M.D., Dermatologist, discusses a new treatment for people that have unsuccessfully tried other treatments for Psoriasis

Risk Factors

Both smoking and alcohol consumption are considered risk factors for psoriasis and may increase the severity of outbreaks.

Menter A et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J American Academy of Dermatology 2009;60:643-659.